Identification of Critical Waste on Outpatient Installation in

Universitas Sumatera Utara (USU) Hospital

Khalida Syahputri

, Rahmi M. Sari, Erwin

, Indah Rizkya

, Mangara M. Tambunan

and Ikhsan Siregar

Industrial Engineering, Faculty of Engineering, Universitas Sumatea Utara, Jl. Almamater Padang Bulan, Medan,

Indonesia

Keywords: Critical Waste.

Abstract: Increasing the number of existing hospitals leads to increase a competition among hospitals. This condition

causes hospital to become more competent by improving existing services, as well as providing continuous

healthcare quality to every patient. Service system at outpatient installation of USU Hospital in BPJS patient

often experiencing problem because there are still many waste at each part and patient service process

become inefficient. Therefore, it is necessary to analyze critical waste identification to know the most

dominant waste occurring in the process to doan action as soon as possible. The results obtained from the

identification indicates that the most critical waste in BPJS patient service process is waiting, where the

patient must wait for a long time starting from the registration process, inspection at polyclinic, and

medicine- taking at the pharmacy.

1 INTRODUCTION

Hospital is a part of health resources are needed

in supporting the implementation of health.

Increasing the number of existing hospitals leads to

increase a competition among hospitals. This

condition causes hospital to become more competent

by improving existing services, as well as providing

continuous healthcare quality to every patient.

Hospital services are now capital-intensive, labor-

intensive, and technology-intensive in facing of

global competition. Health care in hospitals is not

only curative, but also rehabilitative which is both

properties are implemented in an integrated manner

through promotional and preventive efforts (UU RI

No. 44 2009 About Hospital). Thus, the goal of

hospital health services is not only for individual

patients, but also for the families of patients and

general public.

The study was conducted on an outpatient

installation at USU hospital located in Medan.

Outpatient installation is one of the existing

installations at USU Hospital and has a special role

in treating patients who need the treatment. The

process flow of the outpatient installation begins

with the queue number-taking, registering at

registration section, investigating by the doctor at

the clinic, such as blood checks, CT scan, X-rays,

and other investigations if necessary, and medicine-

taking after medicine recipe by doctor at the

pharmacy. Registration in the registration section is

done by checking the patient card for the old patient

while the new patient will perform the personal data-

filling to input in medical record. After registering,

patient moves to the clinic to check with the doctor.

In this installation, there are 13 polyclinics consistof

anesthesia poly, cardiac poly, ENT poly, eye poly,

surgical poly, nerve poly, internist poly, pediatric

poly, child development poly, pulmonary poly,

obgyn poly, polyurium and genital poly, bone poly,

and urology poly. After the investigation on one of

the polyclinics is completed, the patient will receive

a medicine recipe from the doctor if there is no

investigation is required and go to the pharmacy to

medicine-taking. If investigation is required, the

patient will go to the laboratory for investigation and

return to the polyclinic by bringing the investigation

results after the investigation is complete. After that,

the patient will receive the medicine recipe by the

doctor and the patient go to the pharmacy to

medicine-taking.

Outpatient installation at USU hospital treats

general patients and BPJS insurance patients where

the process of these two patients is only different at

the end of the process. The general patient make a

196

Syahputri, K., Sari, R., Erwin, ., Rizkya, I., Tambunan, M. and Siregar, I.

Identiﬁcation of Critical Waste on Outpatient Installation in Universitas Sumatera Utara (USU) Hospital.

DOI: 10.5220/0010075601960199

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

196-199

ISBN: 978-989-758-449-7

payment after medicine-taking at the pharmacy as

doctor medicine recipe while the BPJS

insurancepatient does not need to make the payment.

Patients BPJS insurance at USU hospital more than

the general patient and BPJS insurance patients

become the focus in this study. In the flow process

of patient BPJS insurance, there are many problems

due to a lot of waste on registration process,

investigation by the doctor, and medicine-taking at

the pharmacy. This is because there is still a lot of

waste occurs at each section and patients must queue

and wait for a long time at each process. This

problem leads to patient satisfaction on the

reduction service and critical waste is needed to

identify each process in order to make repairs

immediately.

Waste identification done by the activities

description occurs of the service process into value

added activities,necessary but non value added

activities, and non value added activities lean

approach (Syahputri, 2017). Lean is acontinuous

effort to eliminate waste and increase the value

added of products or services to provide value to

costumer value (Gaspers and Fontana, 2011).

However, the concept of lean applied in service-

based fields. Lean in the field of service assumes the

same principle, namely continuous improvementand

waste. These principles are also currentlyapplied in

many service businesses for examplecall centers,

health care, higher education, software

development,and other professional services

(Ikatrinasari and Haryanto, 2014). Lean healthcare is

a strategy focused on eliminating inefficiencies and

giving more time to patient service activities(Lestie,

2006).

Many previous studies have been conducted in a

medical center or hospital in the world to identify

waste using a lean healthcare approach. One study

was conducted at Virginia Mason Medical Center in

Washington. The same study has also been

conducted at the anatomical pathologylabusing lean

methods (Spear, 2005). However, there is still many

research with lean healthcare done in hospital in

Indonesia especially in Medan City. This research is

aimed to identify waste from service process to

reduce waste happened in outpatient installation, and

service quality and increase consumer satisfaction.

2 METHODOLOGY

In this study object of this study is the flow of

outpatient installation process of USU hospital

specially BPJS insurance patient. Research begins

by making observations to see and observe the

condition occurs in the outpatient installation. After

that, determines the purpose of research in

accordance to existing conditions on the outpatient

installation. Based on the purpose of research, data

collected as input in problem solving. The data

collected for data processing in the form of waste

occurs at each process, the patient processing time at

each part, and waiting time of the patient. Based on

these data, data processing done as a solution to

problems that occurs in the outpatient installation.

The research is done by using lean concept. This

approach is one of the best practices to identify

waste that occurs in the work environment (Ehrlich,

2002) .Lean is a production practice aims to

minimize waste along the value streams mapping

and create more value to customers. According to

lean principles, many use of resources does not

deliver consumer value is a target for change,

reduction or elimination (Arfman, 2014).

Problem solving with lean approach is done with

several stages. The first stage is to map the service

system of outpatient installation of USU hospital.

The purpose of mapping is to know the process

occurs in the outpatient installation of USU hospital

at this time. Mapping is done by describing the

service process of outpatient installation starting

from the arrival of the patient until the patient

returns. The result of this service installation system

mapping is called the current state mapping service

system and the flow of BPJS insurance patient

service process on the outpatient installation of USU

hospital. After obtaining big picture mapping, the

next step is to identify the activity along the service

system on the outpatient installation. This

identification is done to know and calculate the

percentage of activities including value added, non

value added but necessary, and non value added

categories. After the percentage at each activity is

obtained, the next step is to identify the waste occurs

in the service system of the outpatient installation.

This waste identification aims to determine the

waste occurs during the process and causing the

patient service process be ineffective. Next stage is

critical waste identification from the eight waste by

distributing questionnaires to patients.

3 RESULT AND DISCUSSION

3.1 Current State Mapping

The process of describing the current state mapping

service system on the outpatient installation of USU

hospital is done from the arrival of the patient until

Identiﬁcation of Critical Waste on Outpatient Installation in Universitas Sumatera Utara (USU) Hospital

197

the patient returns. Current state mapping of service

system BPJS insurance patient on an outpatient

installation in USU hospital can be seen in Figure 1.

Figure 1: Current State Mapping of Service System BPJS Insurance Patient on an Outpatient Installation in USU hospital.

Based on the figure above, it shows that the

patient waiting for a long time at each part of the

process flow. This is causing by several things such

as a doctor has not arrive yet, the patient's medical

record has not reached the clinic and doctor can not

investigate the patient, and other causes makes the

patient queue at each section.

3.2 Identification of Value Added, Non

Value Added but Necessary, and

Non Volue Added Activities

Identification is done by calculating the percentage

at each activity after the activity is categorized

according to the mapping on the current state

mapping. The classification of activities is based on

the type of activity in the organization (Hines,

2000).

Percentage of outpatient service activity for BPJS

patients insurance can be seen in Table 1.

Table 1: Percentage of Outpatient Installation Service

Activity for BPJS Patients Insurance.

Category Percentage

Value added 12,73%

Necessary non value added 45,40%

Non value added 41,93%

Based on the table above obtaines that the

outpatient installation service process for patients

BPJS insurance producing necessary non-value

added value activity of 45,40%. This result shows

that there is still a lot of activity that necessary but

it’s not give value added because waste occurs in the

service system and more identification is needed to

identify the waste.

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

198

3.3 Identification of Waste in BPJS

Insurance Patient Service Process

Before determining the critical waste occurs in the

outpatient installation service system, first stage is

identify the wastes occurs in the system. Waste

identification during the BPJS insurance patient

service process on an outpatient installation is

waiting, overprocessing, and inventory. Waiting

occurs when the patient waits at each process, such

as queuing for the registration process, queuing for

examination with the doctor, and queuing to take

medication at the pharmacy. Overprocessing occurs

in the medical record where the patient must wait for

the results of medical records to doctor investigation

because medical record process has not optimal yet

and irregular. Inventory occurs when doctors have to

replace the medicine recipe because medicine are

not available at pharmaciy.

From these four wastes, determines the critical

waste by distributing questionnaires. The results of

the questionnaires distribution shows that from the

four wastes occurrs during the outpatient installation

service process, waste waiting is the most critical

waste which is the condition causes waiting

processing every patient service process on the

outpatient installation starting from the registration

process, the investigation on the polyclinic section,

and the medicine-taking in the pharmacy.

4 CONCLUSIONS

The process of patient service has not optimal yet

done by waste identification in the process. This

waste identification aims to determine the waste

occurs during the process and causes the service

process to the patient be ineffective. The results

obtaines that the identification indicates the most

critical waste in the BPJS insurance patient service

process is waiting, where the patient must wait for a

long time starting from the registration process,

investigation on the polyclinic, and medicine- taking

at the pharmacy.

ACKNOWLEDGEMENTS

Author would like to thank to Directorate of

Research and Development for Higher Education

Society (DRPM DIKTI) 2018 for funding the

financial support in this research. We appreciate the

efforts of all who have cooperated in conducting this

study.

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